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Abdominal aortic aneurysm (AAA) is a major public health burden that continues to increase as the population ages. Prognosis associated with AAA rupture is grim, as mortality is high even if open surgical repair is instituted. Endovascular AAA repair (EVAR) is a revolutionary, minimally invasive alternative to open surgery that significantly reduced operative mortality from repair of either ruptured or intact aneurysms. Designed in the 1980s and first implanted in humans in 1990, the EVAR stent graft is composed of a self-expanding metallic stent frame covered with impermeable fabric. The stent graft is crimped into a catheter-based delivery system, most commonly via femoral artery access. While surgical cutdown is the most common method of vascular access, the percutaneous technique is rapidly gaining popularity as it is the least invasive of the access strategies. There are multiple EVAR devices currently available, most of which are modular in design. Each device has its own specific anatomic criteria for eligibility and instructions for use (IFU). Adherence to these criteria and IFU is strongly recommended, as off-label use is associated with significant increase in morbidity and mortality. While the efficacy and durability of the EVAR procedure is well established, short-term and long-term complications that require reintervention are not uncommon. These include four types of endoleaks. Periodic surveillance imaging is, therefore, mandatory after EVAR to prevent late aneurysm rupture by monitoring for aneurysm growth, endoleak, device migration, or mechanical failure. |
